Campbell River and North Island Schizophrenia Society

Campbell River Branch

Psychosis is a medical condition that affects the brain. It is characterized by a loss of contact with reality. A person experiencing psychosis finds it difficult to tell what is real from what is not real. They may also find they are overwhelmed by sights and sounds of things around them.

When this happens, it is called a psychotic episode. A psychotic episode is a period of time when symptoms are intense and interfere with a young person's life. It may last only a short period of time - or it may continue for weeks, months, or even years unless the person receives proper medical treatment.

"First episode psychosis" refers to the first time someone experiences psychotic symptoms. Often, the person will not understand what is happening. Symptoms are unfamiliar and education or knowledge about mental illness, their fear may be increased by negative myths and stereotypes.

We often talk about psychosis as if it were one illness, but it is actually a cluster of symptoms that can occur in a number of medical disorders, or sometimes as a consequence of drug or alcohol use.

Types of Psychosis

Bipolar Disorder (Manic Depression)

Bipolar disorder is characterized by unusual shifts(extreme highs and lows) in a person's mood, energy, and ability to function. Severe episodes can include psychotic symptoms.

Brief Reactive Psychosis

Psychotic symptoms may arise suddenly in response to major stress in someone's life, such as a death in the family or other important change of circumstances. Symptoms can be severe, but the person makes a quick recovery in only a few days.

Delusional Disorder

Strong beliefs that are not based in reality. Paranoia (belief that you are being persecuted) is the most common type of delusion.

Drug-Induced Psychosis

Psychosis can emerge with the use or withdrawal from certain drugs. Recreational drugs and hallucinogens such as PCP, amphetamines, cocaine, marijuana, or alcohol may trigger a psychotic reaction. Symptoms usually disappear as the substance wears off, but sometimes the psychosis remains. Some people who abuse drugs and alcohol may also have an underlying chronic psychotic illness.

Major Depression

Psychotic symptoms sometimes occur in severe depression.

Organic Trauma

Psychotic symptoms may appear after a head injury or infection that disrupts brain functioning. There are usually other symptoms present, such as memory loss or confusion.

Postpartum Psychosis

Psychosis associated with childbearing is rare, but when it happens it usually occurs after a baby is born rather than during pregnancy.

Schizophrenia Psychosis is common in schizophrenia, a brain disorder characterized by hallucinations and delusions. Other less dramatic symptoms include social isolation, withdrawal, disorganized thoughts, unusual speech, bizarre behavior, lack of energy, and lack of interest in routine activities.

Schizophreniform Disorder

This diagnosis is usually given when psychotic symptoms have lasted for less than six months (but more than one month).

Schizoiaffective Disorder

A person diagnosed with schizoaffective disorder shows symptoms of schizophrenia and a mood disorder (depression or bipolar disorder), occurring at the same time or alternating over time.

Phases and Symptoms of Psychosis

"He would sit and stare at his hands for hours. When I asked what was wrong with his hands, he would say they were different then they used to be."

Families often recognize problem signs in a loved one-mood swings, problems with school or friends-and are troubled by them. These changes can be the first signs of emerging psychosis. But it can be hard for the family to identify the emerging illness, or to know what to do about it.

Most psychotic episodes have three phases. These vary in length from person to person. Symptoms also vary from person to person, so individuals may have very different experiences.

Phase 1: Prodrome

In the beginning phase, clear signs of psychosis have not yet appeared. Early signs are often a combination of minor changes that are barely noticeable. But they are enough to make someone feel different, and often to seem different to those who know them well. Prodrome is often described as 'something is not quite right'. Signs are fairly general, so they may be seen as normal adolescent behavior or "just a phase". Or sometimes changes are attributed to drug use.

"In phone calls, my brother's voice no longer had the same tone of excitement and humour; instead it was very flat. At the same time he began to tell us about a situation at work that just didn't seem possible; he was complaining that a group of fellow workers were out to get him." -Sibling

Early signs can include:

Feeling sad or depressed most of the time

Withdrawal from family and friends

Decline in school or work abilities

Irritability

Reduction in energy and motivation

Feeling paranoid or suspicious about other people and their actions

Noticing a change in the way things look or sound

Noticing things that other people don't notice

Feeling anxious

Memory or concentration difficulties

Sleep disturbances

Phase 2: Acute Phase (Psychotic Episode)

"A few months ago, I was happy and full of life. Now I don't want to be around my friends. It's really hard for me to focus on school and I get confused. I hear voices that say mean things. No one believes these voices are real. I don't understand what is happening to me."

Typical psychotic symptoms emerge in the acute phase. These are hard to miss as they interfere with the young person's day-to-day functioning. They are intense, active and continuous. In the acute phase of psychosis, people lose touch with reality. Thoughts, feelings and perceptions can all be seriously affected.

Psychosis can cause changes in thinking, emotions, and behaviour.

The main symptoms during the acute phase are grouped into three categories: positive, negative, and disorganized (or cognitive) symptoms.

Positive Symptoms

Positive as used here does not mean good. It refers to having symptoms that ordinarily should not be there. Positive Symptoms include:

Hallucinations: Hearing, seeing, tasting, smelling, or feeling things that are not there. Although these perceptions are not real, they feel very real to the person experiencing them. People with psychosis often hear voices. Sometimes the voices are threatening or condemning; they may also give direct orders such as, "kill yourself". There is always a danger that such commands will be obeyed.

People who are ill may also have visual hallucinations-a door in a wall where no door exists; a bird, a tiger, or a long-dead relative may suddenly appear. Colours, shapes, and faces may change before the person's eyes.

There may also be hypersensitivity to sounds, tastes, and smells. A ringing telephone might seem as loud as a fire alarm bell, or a loved one's voice as threatening as a barking dog. Sense of touch may also be distorted. Someone may literally "feel" their skin is crawling. Ore, conversely, they may feel nothing, not even pain from a real injury.

Delusions: False beliefs that have no basis or evidence in reality. Again, the person is convinced these beliefs are true and cannot be swayed by arguments or logic. Attempts at reasoning or discussion usually only lead the anger or mistrust.

Examples of common false beliefs include:

Being followed or monitored

Being plotted against

Having special abilities or "powers"

Overheard comments or song lyrics are being specifically directed to the person, and may contain secret messages or meaning

Thoughts are being controlled by other people or other forces

Thoughts are being broadcast so others can hear them

Someone who is experiencing such profound and frightening changes will often try to keep them a secret.

There is often a strong need to deny what is happening, and to avoid other people and situations where the fact that one is "different" might be discovered. Intense misperceptions of reality trigger feelings of dread, panic, fear, and anxiety-natural reactions to such terrifying experiences.

Negative Symptoms

"Negative" refers to a loss of normal function - everyday things the person used to do or express that are now lacking. Examples of negative symptoms include:

Loss of energy or motivation

Trouble starting or pursuing goal-directed activity

Loss of everyday skills the person had before they became ill

Lack of spontaneity and difficulty in conversation

Social withdrawal

Self neglect -- poor diet and hygiene

Loss of pleasure in events, objects, and relationships with others.

In addition to the positive and negative symptoms described above. Psychosis can also affect cognition - the ability to think, plan, make decisions, and remember - as well as emotions and behaviour.

Disorganized (or Cognitive) Symptoms

Psychosis can cause difficulties with concentration and the ability to remember things. A person with psychosis may appear to be preoccupied or daydreaming. Cognitive problems affect the ability to plan, make decisions, complete tasks, follow a conversation, or remember details such as keeping an appointment. Thoughts may seem to go "too fast", or "too slow".

Such cognitive difficulties can be observed in conversation. Jumbled thoughts or thoughts that are sped up or come very slowly make it hard for others to follow what the person is saying.

Emotional Symptoms

Changes in emotion are often reflected in emotional responsiveness. There may be lowered responsiveness. There may be lowered responsiveness - often referred to as a "blunting" of emotion.

Speech may lack normal inflection. Facial expression and gestures seem mechanical. Eyes may gaze blankly at nothing in particular. Even when the emotion is there, the person's expression may not appropriately reflect their feelings. There may be an absence of typical responsiveness. Some people report they no longer experience pleasure and their sense of caring is reduced. Others describe a loss of ability to react emotionally and a restricted range of emotions.

On the other hand, someone with psychosis may express feelings that are completely out of line with a typical response - for example, laughing at a sad story. Laughing inappropriately or becoming angry or upset for no apparent reason are common symptoms of psychosis.

Changes in Behaviour

Changes in behaviour are subtle at first, but become more pronounced as the illness progresses. A person with psychosis may have trouble with everyday tasks such as bathing or preparing meals. Or they may display odd behaviour such as mutter aloud, shouting or swearing on public, or dressing inappropriately, e.g., wearing many layers of clothing on a hot day.

General deterioration in normal school or work activities, and withdrawal from family and friends are also commonly observed. Other behavioural changes may include becoming very lethargic, sitting around all day, or staying up all night.

Psychosis is usually very upsetting for the person experiencing it, and quite incomprehensible to others. Most people with psychosis are totally unaware of the strangeness of their behaviour, but will suffer feelings of embarrassment once the episode has passed. Most episodes of psychosis can be effectively treated with medication.

Phase 3: Recovery

Psychosis is treatable and most people recover. The pattern of recovery varies from person to person. For some people, symptoms disappear quite quickly, and they are able to resume their lives with minimal disruption. Others may take more time (several weeks or months) to recover. A small proportion of people who experience psychosis will need ongoing medication and support for many years.

Following recovery, a significant number of people will never have another psychotic episode. The risk of relapse is greatly decreased when treatment is continued and monitored regularly. Learning to manage stress and avoiding drugs and alcohol also decreases the risk of relapse.

People recover from first-episode psychosis. Many never experience another psychotic episode.

Why is Early Intervention Important?

A first episode of psychosis can be very stressful and frightening for a young person. It is also distressing for family and friends. The onset of a psychotic disorder usually occurs at a critical time in development. Typically, it happens just as the young person is establishing their self identity, forming key relationships, and pursuing education and career goals.

Treatment delays result in damage to the person's ability to function, strained family relationships, social isolation, and disruption in education and employment. Untreated psychosis also increases the risk of depression, suicide and violence. The earlier psychosis is recognized and treated, the better the outcome. This means fewer hospitalizations, less severe symptoms, earlier remission, fewer relapses, less disruption to the young person's development, and an improved quality of life.

Being able to treat psychosis early greatly increases the person's chances of enjoy a healthy and productive future.

Benefits of Early Intervention

Individuals do not suffer unnecessarily

Faster, more complete recovery; reduced disruption to activities

Better prognosis (outcome)

Less disability and fewer relapses

Decreased risk of depression and suicide

Less interference with psychological and social development

Less strain on relationships, family, and social supports

Less disruption of study and/or employment

Less disruption of parenting ability if the person has children

Lowered risk of substance abuse, violence or criminal activity

Lowered risk of unnecessary hospitalizationMore able to maintain self esteem, self-identity, and confidence

"He would frequently be up all night pacing in his bedroom after barricading the bedroom door with furniture so that the unseen enemy couldn't get him. Then he would sleep until 2pm or 3pm - only to get up, eat, and then sit down to stare into space."